Marc Bernardo, DMD, MPH, and Michelle Galeon, DMD, are among the first recipients of a new grant funded by Proposition 56, a voter-approved tobacco tax that CDA and other health care organizations sponsored in 2016. The grant program awarded $10 million in debt relief to 38 dentists (up to $300,000 each) in exchange for the dentists maintaining a 30% or more Medi-Cal patient caseload for five years.

The Department of Health Care Service’s new program designed to expand access to care for Medi-Cal patients has awarded $10.5 million to 40 dentists to pay student loan debt. Approximately 1,300 health care providers, including 350 dentists, applied to the CalHealthCares program, which offers up to $300,000 in debt relief in exchange for meeting certain criteria.

To understand how well the Dental Transformation Initiative program is meeting its goals, the Department of Health Care Services has contracted with Mathematica, an external, independent research organization, to evaluate DTI as outlined in the Centers for Medicare & Medicaid Services Special Terms and Conditions.

As part of the finalized 2019-20 California state budget, the Legislature and Gov. Gavin Newsom approved a continuation of supplemental Medi-Cal provider rates, including significant dollars for dentists serving Medi-Cal patients. An additional $20 million was dedicated to dentists through a recently launched student loan repayment program.

Dentists who want to better understand recent changes to the Medi-Cal Dental Program, including the substantial rate increases and a streamlined application process for providers, can attend a course this May at CDA Presents The Art and Science of Dentistry in Anaheim. The course is hosted by CDA Public Affairs and is intended both for current and potential providers.

A new loan repayment program is available for dentists and physicians who provide direct patient care to Medi-Cal beneficiaries. Eligible dentists may apply through Physicians for a Healthy California to receive up to $300,000 to apply toward their student loans in exchange for a five-year service obligation as a Medi-Cal provider.

Silver diamine fluoride would become a covered benefit as a treatment option for tooth decay for specified Medi-Cal Dental Program enrollees under a new bill authored by Sen. Richard Pan. Senate Bill 154 would make SDF a covered benefit if applied as part of a patient’s comprehensive treatment plan and with the patient’s written informed consent.

Dentists in 26 counties have a new opportunity to participate in the Dental Transformation Initiative to help improve dental health for low-income children enrolled in the Medi-Cal Program while receiving enhanced reimbursement by meeting specific incentive metrics. As part of California's 1115 waiver, the DTI focuses on high-value care, improved access to dental care, and the use of performance measures to improve the program through four “domains.”

Through the improved Medi-Cal Dental Program, more than 13 million individuals are eligible for dental benefits, and a streamlined application and significant rate increases are prompting more dentists to join the program as providers. The changes follow years of action to improve the program, including CDA’s efforts to educate the public and policymakers about the importance of good oral health care. Jennifer Kent, director of the California Department of Health Care Services, in this Q&A discusses the program’s recent changes and what dentists can expect as providers.

Preliminary criteria for the Prop. 56 Dental Loan Repayment Program were recently announced by the California Department of Health Care Services. The program will repay up to $300,000 toward student loans for dentists who commit to serving Denti-Cal beneficiaries. Applications will open this spring with participants selected no later than July 1.

A campaign to increase Medicaid-enrolled members’ use of Medi-Cal’s dental benefit was launched recently by the California Department of Health Care Services as part of an integrated plan to improve the overall performance of the state’s dental program. The “Smile, California” campaign will educate eligible members about the free and low-cost services available to maintain good oral health and make it easier for members to access care. Outreach efforts also focus on recruiting and maintaining providers.

At the children’s dental clinic that Dr. John Blake runs in Long Beach, children as young as 2 or 3 show up with blackened teeth and swollen faces, unable to eat because of the pain and in need of whole mouth restorations. In California, tooth decay in children outpaces the national average. Hoping to save both teeth and money, the state is addressing the problem with an overhaul of Denti-Cal, part of the Medi-Cal health system for low-income Californians.

New state revenue from the taxation of tobacco products, along with support from legislators and Gov. Jerry Brown, is putting over half a billion dollars toward increased Medi-Cal dental provider reimbursements for 2018-19. The higher reimbursement follows years of activity to improve the Medi-Cal dental program and increase access to oral health care for California’s 13.5 million Medi-Cal members.

Promising changes to the Medi-Cal dental program, including substantial rate increases and a streamlined provider application that saves applicants significant time, are making it more enticing for dentists to become Denti-Cal providers. Now, dentists have an opportunity to learn the details about these changes and additional Denti-Cal program investments at CDA Presents The Art and Science of Dentistry in September.

Denti-Cal providers and beneficiaries in nine counties impacted by the Carr and Cranston fires will receive processing exceptions to expedite replacement of removable dental appliances, a special Denti-Cal Bulletin states. According to the August Bulletin, claims will be accepted without requiring prior authorization and will not be rejected due to frequency limitations for subsequent removable appliances for eligible beneficiaries.

The 2018-19 state budget signed by Gov. Jerry Brown dedicates $210 million from the Proposition 56 Tobacco Tax revenue to Denti-Cal providers, a $70 million increase from last year’s amount. And a new aspect in this year’s budget is an additional one-time allocation of $30 million toward a program that would repay student loans for dentists who commit to serving Denti-Cal beneficiaries and locate their practice in a county or region that lacks adequate providers.

California's Little Hoover Commission, an independent state oversight agency, held a special hearing March 22 to assess progress within the Denti-Cal program since the commission released the April 2016 report titled Fixing Denti-Cal. The commission heard from several panels, including Denti-Cal providers who serve the population in a variety of settings. CDA member dentist Nagaraj Murthy, DDS, spoke about his experiences as a long-term Denti-Cal program provider.

CDA is sponsoring new legislation that will allow dentists who provide care in the Medi-Cal dental program to be reimbursed when using silver diamine fluoride as a caries arresting agent. With the passage of Senate Bill 1148, SDF will be placed in dentists’ tool belts as an evidence-based option to manage dental caries when used as part of a comprehensive treatment plan, particularly beneficial with patients who present challenges to receiving traditional treatment.

Beginning Jan. 1, 2018, adults enrolled in the Denti-Cal program are eligible for an expanded set of dental benefits. The Department of Health Care Services on Nov. 9 issued a special provider bulletin to clarify the dental services that providers may render, bill and be reimbursed for by Denti-Cal in 2018, including scaling and root planing, partial dentures and posterior root canals.

Despite broad bipartisan support, Congress neglected to take action to extend Children’s Health Insurance (CHIP) funding before it expired Sept. 30. The consequences of Congress’ delay are creating stressful uncertainty for states and families across the country. Sixteen states, including California, will run out of funding for the CHIP program by the end of January. CDA is calling on its members to help protect coverage for children and hard-fought improvements in the Denti-Cal program.

Significant rate increases for hundreds of procedures covered by Denti-Cal have been approved by the federal government. The supplemental payments of 40 percent are the result of CDA-sponsored Proposition 56 and the unprecedented investment of $140 million in the Denti-Cal program, which will be matched with federal dollars for a potential total of $350 million for fiscal year 2017-18.

California’s CHIP funding will run out next month and the state will be confronted with a huge budget gap for CHIP children’s Medi-Cal coverage, potentially as much as $1 billion dollars or more. CDA is calling on dentists to act now to protect dental and health care coverage for millions of children and pregnant women in California. Contact your senators and representative in Congress to urge them to take swift action to extend CHIP funding.

More than 7 million adults enrolled in Denti-Cal, California’s Medicaid dental program, will have a fully restored package of dental benefits in 2018. The adult benefit package was drastically cut in 2009 due to the state budget crisis and was partially restored in May 2014. The restoration of the adult dental benefit services is a result of legislative action taken during the 2017-18 budget process.

The Department of Health Care Services on June 30 announced hundreds of procedure codes will receive a 40 percent supplemental rate increase as the result of Proposition 56, the tobacco tax measure sponsored and supported by CDA and approved by voters last November. Over $1 billion of the tobacco tax revenue is allocated to improved payments to physicians and dentists who treat Medi-Cal patients.

A new analysis from the California Department of Health Care Services and the Department of Finance finds that California could face more than $30 billion annually in additional health care costs over the next decade under the Senate proposal to repeal and replace the Affordable Care Act. The Senate bill, called the Better Care Reconciliation Act (BCRA), would increase state costs even more than the $24.3 billion estimate under the House’s American Health Care Act proposal. A comparative chart offered here outlines the current proposals and the implications nationally.

As California’s new fiscal year starts, dentists can expect significant reimbursement increases for hundreds of procedures covered by Denti-Cal because of the passage of CDA-sponsored and supported Proposition 56, the tobacco tax measure. With anticipated federal participation, it is expected that an estimated $300 million in additional funding will be committed to increasing coverage for dental care in the program.

Gov. Jerry Brown and the California Legislature engaged in heated negotiations before passing a final budget by a constitutionally mandated deadline of June 15. A major focus of those negotiations was the use of Proposition 56 tobacco tax revenues, for which CDA and its partners engaged in an internal and external advocacy campaign.

Each year, the Denti-Cal patient referral list is “refreshed” to help ensure it is current and accurate. Toward this goal, dentists who were added to the Denti-Cal patient referral list prior to Dec. 1, 2016, and who wish to remain on the list must complete and submit a new Medi-Cal Dental Patient Referral Service form within 35 business days of receiving the form. The form was mailed to providers on March 10.

The California Department of Health Care Services will present two different programs at CDA PresentsThe Art and Science of Dentistry this year that highlight the incentive opportunities available through the Dental Transformation Initiative and provide insight on how to successfully navigate the most common challenges Denti-Cal providers face.

In February 2017, the Department of Health Care Services announced the 15 selected proposals for Local Dental Pilot Project (LDPP) funding, with awards totaling $150 million over four years. Local Dental Pilot Projects are one of the four domains of the Dental Transformation Initiative and part of California’s 1115 waiver, or Medi-Cal 2020. The DTI represents a huge $740 million investment in the Denti-Cal Program and the oral health of Californians.

First-time resources available to participating Denti-Cal providers resulted in increased access to care for the nearly 6 million California children enrolled in the Medicaid dental program in the first half of 2016. In 2016, the Department of Health Care Services rolled out the 1115 waiver, known as Medi-Cal 2020, which allocated $740 million to the Dental Transformation Initiative.

The 2017-18 state budget proposed by Gov. Jerry Brown calls for using tobacco tax-generated funds from Proposition 56 to offset the state’s current obligations to Medi-Cal rather than provide additional funding for provider reimbursement rates. This proposal disregards the will of the voters and the ballot measure’s provisions.

Dentists in California now have an opportunity to participate in the Dental Transformation Initiative to help improve dental health for low-income children enrolled in the Denti-Cal program, while receiving enhanced reimbursement by meeting specific incentive metrics. As part of California's 1115 waiver, known as Medi-Cal 2020, the DTI focuses on high-value care, improved access and utilization of performance measures to drive delivery system reform.

Under the provisions of the American Recovery and Reinvestment Act, participating Denti-Cal providers may receive up to $63,750 in incentive payments for implementing an electronic health record system and eventually achieving “meaningful use.” The program will close to new registrants on Dec. 31, and any dentist who has not started in the incentive program will lose the opportunity to claim those dollars.

Beginning in January 2017, dentists in select California counties will have an opportunity to participate in an innovative pilot that seeks to assess and manage caries risk and emphasize the provision of preventive services to Denti-Cal-enrolled children ages 6 and under.

In the final weeks of the state’s 2016 legislative session, Gov. Brown signed into law several bills that impact dentists, including CDA-sponsored Assembly Bill 2485 (Santiago, D-Los Angeles). Taking effect immediately as an urgency statute, AB 2485, the Dental Corps Loan Repayment Program, revises in the applicant’s favor provisions regarding program eligibility, application, selection and placement.

The deadline to apply for Local Dental Pilot Project funding under Domain 4 of the Dental Transformation Initiative is Saturday, Sept. 30. Fifteen pilot projects will be selected to commence in January 2017.

A retooled and refocused lecture on the Denti-Cal program will take place at CDA Presents The Art and Science of Dentistry in San Francisco in September. Presented by CDA’s Public Policy department and the California Department of Health Care Services, “The Ins and Outs of California’s Denti-Cal Program” will highlight the many recent improvements to Denti-Cal.

The deadline to apply for Local Dental Pilot Project funding under Domain 4 of the Dental Transformation Initiative has been extended to Sept. 30 as a result of a delay in the development of a budget template for the application. The California Department of Health Care Services opened its application cycle for LDPP proposals developed under the Medi-Cal 2020 Waiver June 1.

The state Assembly has unanimously approved legislation that begins to address administrative problems in the Denti-Cal program recently highlighted in a scathing report by California’s Little Hoover Commission (LHC), an independent state oversight agency.

CDA is urging the state to take immediate steps to improve its Medi-Cal dental program, Denti-Cal, after the release of a highly critical report by the Little Hoover Commission, an independent state oversight agency.

The state Legislature and governor recently agreed to a deal, supported by CDA, that will preserve $1.3 billion in federal funding for Medi-Cal. The agreement reforms the state’s managed care organization (MCO) tax to comply with federal requirements that the tax apply to all managed care health plans, not just those that serve Medi-Cal patients, in order to preserve the federal matching money the tax brings to the state.

In a significant victory for CDA advocacy, the California Department of Health Care Services has announced that the federal Centers for Medicare and Medicaid Services (CMS) has approved the 10 percent rate cut reversal for dental services that was included in the 2015-16 California budget. CDA strongly advocated for the rate cut reversal, which applies to Denti-Cal and not broadly to all Medi-Cal providers.

California and the federal government have reached a significant agreement that will ensure an additional $750 million investment in California’s Denti-Cal program over a five-year time frame. The majority of the funding focuses on the medical portion of the state’s Medicaid program, including investments in the state’s public hospital system and a county-based pilot project to provide more integrated care for high-risk, vulnerable populations. The goal is to reform the delivery system and develop outcome improvements with the long-term goal of reducing costs to the state and federal government.

CDA participated in a special hearing recently to review the deficiencies of the state’s Denti-Cal program. An independent oversight committee held a meeting at the state Capitol to delve into the problems highlighted in a report that found that California’s 2014 reimbursement rates for the 25 most common Medicaid dental services were well below those in the comparable states of New York, Texas and Florida.

The California Department of Health Care Services (DHCS) recently released a Denti-Cal Provider Bulletin outlining the modified policy for the administration of general anesthesia and intravenous sedation. Effective Nov. 1, Denti-Cal providers will be required to submit a Treatment Authorization Request (TAR) for the provision of intravenous sedation and general anesthesia services.

A new review of the state’s Denti-Cal program provides further evidence that current rates are insufficient and that there has been a significant decline in participating providers since 2008. Just released by the state Department of Health Care Services, the report shows that while there has been a nearly 40 percent increase in enrolled children and 77 percent increase in enrolled adults, there has been a double-digit decrease in providers in that same timeframe.

The state's reversal of the 10 percent rate cuts for Denti-Cal providers, which have been in effect since 2013, is a positive first step in ensuring access to care for the program's beneficiaries. Gov. Jerry Brown and legislative leaders made an announcement of a budget deal that will allow the rate changes to take effect July 1 pending federal approval.

The federal Centers for Medicare and Medicaid Services (CMS) has again changed the compliance date for dentists desiring to opt out of the Medicare program. The new date, June 1, 2016, comes some two weeks after CMS moved the date from June 1 of this year to Jan. 1 of next year.

The Centers for Medicare and Medicaid Services (CMS) has announced that the new compliance date for enrollment or opt out for dentists to the Medicare program is Jan. 1, 2016. The original deadline was June 1. Dentists are encouraged to consider June 1 as a soft compliance date to get their forms in so as not to have their status or patient benefits lapse while forms are being processed.

CDA is disappointed that the May revision to the 2015-16 state budget released by Gov. Jerry Brown is silent on the statewide crisis in access to dental care and is urging the administration and Legislature to take action in their upcoming budget negotiations.

The U.S. Supreme Court has ruled that providers cannot sue states or state officials in an effort to increase Medicaid reimbursement rates. In a 5-to-4 decision, justices indicated that complaints about low reimbursement rates should instead be filed with the Centers for Medicare and Medicaid Services, the federal agency that oversees the Medicaid program.

CDA's advocacy urging the state to fix the broken Denti-Cal program has captured the attention of lawmakers who expressed outrage in two legislative hearings about the program's failure to provide access to care due to glaring oversight issues and extremely low reimbursement rates. CDA members testified at two joint oversight hearings of the Senate Health Committee, Assembly Health Committee and the Joint Legislative Audit Committees in March.

A requirement dentists need to keep in mind this year is the designation of their status with the Medicare program. CDA is receiving an increasing number of inquiries about what to consider when choosing your status. Conversations with the ADA and the Medicare administrator for California indicate that additional information, and reminders about the requirement, will be needed as the deadline nears.

May 1 marks the date of formal restoration of adult benefits in the Denti-Cal program. CDA offers a few suggestions to help dentists make sure they are prepared for the program to return: familiarize yourself with the benefits available to adults; confirm that you are an enrolled provider in the Denti-Cal program; and attend the lecture that will cover the renewed program at CDA Presents The Art and Science of Dentistry in Anaheim.

Nearly five years after the state eliminated dental benefits for adult beneficiaries in the Medi-Cal program, many of those benefits are being restored as of May 1, 2014. This comes largely as a result of the pent up need for dental care, so visibly demonstrated at CDA Cares.

Denti-Cal providers received positive news Jan. 9 regarding CDA efforts to stop the state from implementing retroactive reimbursement cuts, which were not included in Gov. Brown’s proposed 2014-15 budget. CDA advocated strongly against the 10 percent “clawback” of payments made since June 2011, citing the devastating impact on the provider network and patients’ ability to access care.

Denti-Cal providers received positive news regarding retroactive reimbursement cuts in Gov. Brown’s proposed 2014-15 budget released Jan. 9. The spending plan does not include a 10 percent “clawback” of payments made since June 2011 when the state authorized Medi-Cal reimbursement cuts as part of its budget.

The Department of Health Care Services (DHCS) is implementing cuts for Denti-Cal providers that were originally authorized through the state budget process in 2011. Initially, it was thought that the 10 percent rate cut applied to all services provided on and after Sept. 5, 2013. However, recent clarification by the state explained that it is implementing the cuts on all payment checks cut on Sept. 5 and ongoing, even if the services were provided in previous months.

CDA and a coalition of health care organizations aiming to stop Medi-Cal rate cuts implemented by the state filed a petition with the Supreme Court on Friday. The Petition for Writ of Certiorari asks the Court to reverse the decision by the Ninth Circuit Court of Appeals upholding the rate cuts.

California is reaching the final phases of its transition of the Healthy Families Program (HFP) to the Medi-Cal program. Since Jan. 1, 2013, the children getting health and dental coverage through the HFP have been moving to receive their care through the Medi-Cal program. Approximately 850,000 of the 880,000 children have been transitioned to date. Sept. 1 marked the transition of approximately 8,000 children who live in mostly rural California counties.

After a series of court decisions upholding the legality of the state’s 10 percent reduction to Medi-Cal provider reimbursement rates, the Department of Health Care Services (DHCS) has announced that it will begin implementing the cuts for Denti-Cal providers on Sept. 5. The Department’s announcement states that the prospective rate reduction will be phased in by provider type, beginning with dental and medical transportation and ending with pharmacies, physicians and distinct-part nursing facilities on Jan. 9, 2014.

The California Medi-Cal Dental Program (Denti-Cal) is informing dentists across the state that it is OK to provide dental services to children on Medi-Cal, including foster children, if they come to their office without a BIC (Medi-Cal) card. In a notice recently sent out in the Denti-Cal Bulletin newsletter, the state's Department of Health Care Services clarifies that in accordance with the California Medi-Cal Dental Program Provider Handbook, no identification verification is required in certain circumstances.

In a four-part series, CDA is profiling members who have taken different approaches to how they practice in order to counter changes in the profession such as an overall drop in adults seeking dental care, the decline in the economy and real estate market, increased regulatory compliance, reduced reimbursement rates and more. The second article in the series features two dentists who practice in San Francisco. In 2008, both dentists decided to end their participation as a contracted provider with dental plans. Five years have passed and both continue to operate on one fee schedule.

In a four-part series, CDA is profiling members who have taken different approaches to how they practice in order to counter changes in the profession such as an overall drop in adults seeking dental care, the decline in the economy and real estate market, increased regulatory compliance, reduced reimbursement rates and more. The first article in the series features a dentist who practices in Stockton with a diverse population, including low-income patients. During the last five to 10 years, she has made several changes in her practice to become more efficient.

The effort to restore Adult Denti-Cal benefits is one step closer to reality after the Legislature voted on a new state budget plan. The funding, which is a result of the leadership exhibited by Senate President Pro Tem Darrell Steinberg (D-Sacramento), still needs the governor’s signature. Steinberg made the restoration of Adult Denti-Cal a top priority after his visit last August to CDA Cares in Sacramento.

Two significant but conflicting developments in the longstanding effort to rebuild the oral health care safety net in California have occurred. In a disappointing move, on the same day that the state Senate Budget and Fiscal Review Committee endorsed restoring Medi-Cal adult dental benefits, the U.S. 9th Circuit Court of Appeals on May 24 denied a petition filed by CDA and a coalition of health care organizations aiming to stop the state from implementing a 10 percent reduction in Medi-Cal provider reimbursement rates.

In a positive sign for the millions of Californians in need of access to care, the Senate Budget Subcommittee on Health and Human Services on May 2 discussed the issue of restoring Medi-Cal adult dental benefits. Although no final recommendation was made by the subcommittee, the hearing raised the profile of this issue that has been led by Senate President Pro Tem Darrell Steinberg (D-Sacramento), who has been a vocal champion for bringing back adult dental services since his visit to the CDA Cares free dental clinic held in Sacramento last year.

As part of an effort to simplify providers’ participation in the state’s Medi-Cal Dental Benefits Program (Denti-Cal), CDA, with the cooperation of the State Department of Health Care Services’ Dental Services Department, has developed a guide to working within the program. The guide, entitled “Denti-Cal Provider Guide,” is divided into two main sections: Processing a Denti-Cal Patient Through the Dental Practice; and the Denti-Cal Billing Process.

In the wake of an adverse court ruling last fall, CDA and other stakeholders are pursuing legal and legislative avenues to prevent implementation of a 10 percent reduction in Medi-Cal fee-for-service reimbursement rates, a reduction which if fully implemented would be retroactive to June 2011. The fee reduction was part of a larger state budget deficit reduction agreement, and affected nearly all Medi-Cal providers.

The next wave of the Healthy Families Program transition to the Medi-Cal program is set to occur on April 1. It is important to note that the federal Centers for Medicare and Medicaid Services is requiring the state to again seek approval before they initiate this next phase (Phase 1c). There will be seven counties involved in the transition.

The state of California is currently in the process of transitioning the first phase of children enrolled in the Healthy Families Program (HFP) to the Medi-Cal program. The state was required to get approval from the federal Centers for Medicare and Medicaid Services (CMS), which they received on Dec. 31, 2012, in order to transition the children before Jan. 1.

Acknowledging that California’s economy is improving but still uncertain, Gov. Jerry Brown on Jan. 10 released a 2013-14 budget proposal that calls for expanding Medi-Cal eligibility as part of national health care reform, but makes no move to address calls from legislative leaders to restore optional benefits, such as adult dental, that were cut in prior years in response to fiscal crises.

California is continuing to move forward with the transition of 875,000 children currently enrolled in the Healthy Families Program (HFP) to the Medi-Cal program, which is expected to begin on Jan. 1. For many months, advocates were pushing for the delay of the transition, but recently, many of those advocates have sensed the inevitability of the transition. The focus of many organizations has turned to ensuring the transition goes smoothly for families and on monitoring access to care as the transition occurs.

Earlier this year, Gov. Jerry Brown proposed and the Legislature approved the transition of all 875,000 of the children currently enrolled in the Healthy Families Program to the Medi-Cal program, which includes coverage for medical, vision, as well as their dental care. CDA has prepared this information for members about the transition.